Combined human growth hormone and lactulose for prevention and treatment of multiple organ dysfunction in patients with severe chronic hepatitis B

Growth Hormone Signaling in Liver Diseases: Therapeutic Potentials and Controversies

Growth hormone (GH) and downstream insulin-like growth factor 1 (IGF1) signaling mediate growth and metabolism. GH deficiency causes short stature or dwarfism, and excess GH causes acromegaly. Although the association of GH/IGF1 signaling with liver diseases has been suggested previously, current studies are controversial and the functional roles of GH/IGF1 signaling are still undefined. GH supplementation therapy showed promising therapeutic effects in some patients, such as non-alcoholic fatty liver disease, but inhibition of GH signaling may be beneficial for other liver diseases, such as hepatocellular carcinoma. The functional roles of GH/IGF1 signaling and the effects of agonists/antagonists targeting this signaling may differ depending on the liver injury or animal models. This review summarizes current controversial studies of GH/IGF1 signaling in liver diseases and discusses therapeutic potentials of GH therapy.

Optimization of production of recombinant human growth hormone in Escherichia coli

BACKGROUND

Human growth hormone (hGH) is a single-chain polypeptide that participates in a wide range of biological functions such as metabolism of proteins, carbohydrates and lipids as well as in growth, development and immunity. Growth hormone deficiency in human occurs both in children and adults. The routine treatment for this condition is administration of recombinant human growth hormone (rhGH) made by prokaryotes. Since nonglycosylated human growth hormone is a biologically active protein, prokaryotic expression systems are preferred for its production.

MATERIALS AND METHODS

Different strains of E.coli were transformed by plasmid containing human growth hormone gene and cultured in different conditions. After induction by IPTG, recombinant human growth hormone production was assessed using ELISA, dot blotting and western blotting techniques.

RESULTS

High levels of rhGH were produced using E.coli prokaryotic protein production system.

CONCLUSION

This simple and cost effective production process could be recruited for large scale production of rhGH.

Effects of intestinal intervention on bacterial translocation in a rat model of acute liver failure in vivo

BACKGROUND/AIMS

The study aimed to confirm bacterial translocation (BT) in rats with acute liver failure (ALF), to explore the correlation between the concentration of lipopolysaccharides and Toll-like receptor 4 (TLR4) expression, and further, to evaluate the curative effects of lactulose and montmorillonite (smecta) in this setting.

METHODS

D-Galactosamine was injected into the abdominal cavity of rats to induce ALF. Escherichia coli JM109 labeled with enhanced green fluorescent protein was administered to track BT. Simultaneously, the rats were given lactulose or smecta. Blood samples were collected for measuring liver function, cytokines, endotoxins, and TLR4 expression. Representative tissue specimens from the liver, spleen, and mesenteric lymph nodes were aseptically harvested for bacterial identification by agarose gel electrophoresis, laser scanning confocal microscopy, and flow cytometry.

RESULTS

BT occurred in ALF, accompanied by impaired liver function with increased cytokines, endotoxins, and TLR4 expression. After the treatment with lactulose or smecta, all these parameters decreased, including the relative quantity of translocated bacteria while albumin increased. Furthermore, compared with the lactulose treatment group, the parameters in the smecta treatment group improved. Moreover, in the group in which smecta was given for prophylaxis, there was greater improvement than with treatment.

CONCLUSION

Intestinal intervention with lactulose or smecta can ameliorate BT; moreover, smecta has a better effect than lactulose, and its preventive effect was also better than its therapeutic effect.

Recombinant human growth hormone increases albumin and prolongs survival in patients with chronic liver failure: a pilot open, randomized, and controlled clinical trial

OBJECTIVE

To evaluate the efficacy and safety of recombinant human growth hormone (rhGH) in the treatment of patients with chronic liver failure.

SUBJECTS AND METHODS

One hundred and fourteen patients with chronic liver failure were randomly divided into two groups: (1) 56 patients in the rhGH treatment group received 4.5IU of rhGH intramuscularly daily for 4 weeks and (2) 58 patients in the control-treatment group. Fifteen healthy subjects served as normal controls. Symptoms and complications were recorded. The prognosis was analysed by Kaplan-Meier survival analysis. The serum GH, IGF-1, IGFBP-3, and insulin levels were determined using ELISA.

RESULTS

The efficacy of rhGH treatment was 87.5% (vs. 38.1% in the controls-treatment group, p<0.01). The serum GH, IGF-1, IGFBP-3, and insulin levels in patients with chronic liver failure were significantly different than the levels in the normal controls (5.50+/-4.21 vs. 1.57+/-1.27, 80.45+/-69.99 vs. 172.97+/-78.12, 109.93+/-87.53 vs. 373.41+/-119.07, and 31.99+/-49.87 vs. 6.72+/-1.09, respectively, p<0.05-0.001). The serum IGF-1, IGFBP-3, albumin, proalbumin, and cholesterol levels were significantly increased after rhGH treatment; however, the serum GH and insulin levels were decreased. The survival rate of the rhGH treatment and control-treatment groups after 2 weeks, 1 month, 3 months, and 6 months of treatment was 98.21% vs.75.86%, 91.07% vs.62.07%, 66.07% vs.22.41%, and 55.36% vs.13.79%, respectively. Cox regression analysis showed that rhGH was an independent factor in predicting the survival of patients after 3 and 6 months of treatment with rhGH.

CONCLUSIONS

rhGH replacement therapy increased albumin and tended to improve survival in adult patients with chronic liver failure.

Comparison scoring model of severe viral hepatitis and model of end stage liver disease for the prognosis of patients with liver failure in China

AIM: To estimate the prognosis of patients with liver failure using a scoring model of severe viral hepatitis (SMSVH) and a model of end stage liver disease (MELD) to provide a scientific basis for clinical decision of treatment.

METHODS: One hundred and twenty patients with liver failure due to severe viral hepatitis were investigated with SMSVH established. Patients with acute, subacute, and chronic liver failure were 40, 46 and 34, respectively. The follow-up time was 6 mo. The survival rates of patients with liver failure in 2 wk, 4 wk, 3 mo and 6 mo were estimated with Kaplan-Meier method. Comparison between SMSVH and MELD was made using ROC statistic analysis.

RESULTS: The survival curves of group A (at low risk, SMSVH score ≤ 4) and group B (at high risk, SMSVH score ≥ 5) were significantly different (The 4-wk, 3-mo, 6-mo survival rates were 94.59%, 54.05%, 43.24% in group A, and 51.81%, 20.48%, 12.05% in group B, respectively, P < 0.001). The survival curves of group C (SMSVH scores unchanged or increased), group D (SMSVH scores decreased by 1) and group E (SMSVH scores decreased by 2 or more) were significantly different .The survival rates of groups C, D and E were 66.15%, 100%, 100% in 2-wk; 40.0%, 91.18%, 100% in 4-wk; 0%, 58.82%, 80.95% in 3-mo and 0%, 38.24%, 61.90% in 6-mo, respectively, P < 0.001). The area under the ROC curve (AUC) of SMSVH scores at baseline and after 2 wk of therapy was significantly higher than that under the ROC curve of MELD scores (0.804 and 0.934 vs 0.689, P < 0.001).

CONCLUSION: SMSVH is superior to MELD in the estimation of the prognosis of patients with severe viral hepatitis within 6 mo. SMSVH may be regarded as a criterion for estimation of the efficacy of medical treatment and the decision of clinical treatment.